Natour AK, Shepard AD, Weaver M, Peshkepija A, Nypaver T, and Kabbani L. Re-vascularization Of Left Subclavian Artery May Not Influence The Incidence Of Spinal Cord Injury After Endovascular Repair Of Acute Type B Aortic Dissection. J Vasc Surg 2022; 76(4):e56-e57.
J Vasc Surg
Objective: The objective of this study was to analyze whether left subclavian artery (LSA) revascularization in patients undergoing thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (TBAD) is associated with decreased spinal cord ischemia (SCI).
Methods: The national Vascular Quality Initiative TEVAR module was queried for all procedures performed between 2014 and 2021. Patients presenting with aortic aneurysms or aortic ruptures were excluded from the analysis. Patients with therapeutic spinal drains were excluded as well. Patients were divided into two groups according to whether their left subclavian artery (LSA) was revascularized (prior to or during TEVAR) or not. A propensity score matching approach was used to account for possible confounders and evaluate the effect of LSA revascularization on the primary outcome of SCI.
Results: Among patients who had TEVAR for acute TBAD, 852 patients had the LSA covered. The LSA was revascularized prior to or concomitant with TEVAR in 44% of these patients (n = 378). The incidence of LSA revascularization significantly increased over the study period (Fig) (P <.001). A total of 650 patients were split equally and matched between the two groups. Average age was 57 years, and 71% (n = 458) were male (Table). Spinal cord ischemia developed in 26 patients (4%), and cerebral stroke in 46 patients (7%). On univariate analysis, patients who had their LSA revascularized were significantly less likely to develop cerebral stroke (5% vs 9%; P =.03). However, this association dropped after accounting for preoperative and intraoperative variables (P =.14). No significant difference was seen when comparing SCI, 30-day mortality, or 1-year mortality between patients who had LSA revascularization and those who did not (Table). The average follow-up was 24 months (range, 0-99 months). Long-term survival did not differ between the two groups on Kaplan-Meier analysis.
Conclusions: In patients with acute TBAD undergoing TEVAR requiring LSA coverage, an increasing percentage of patients underwent preoperative or concomitant LSA revascularization over the course of the study: 51% in 2021. In this study, LSA revascularization did not affect the incidence of postoperative SCI, cerebral stroke, or short or long-term mortality. LSA revascularization may carry its own morbidity in TEVAR requiring LSA coverage.